Benefits

Health Plans - UK-HMO and UK-RHP

At a glance: UK-HMO and UK-RHP (Regional Health Plan, formerly UK-HMO RSA) offer quality care through UK HealthCare facilities and physicians (UK-HMO) or other participating providers (UK-RHP). These plans offer the lowest monthly premiums and lowest out-of-pocket costs. No deductible. No out-of-network coverage.

For complete details on the UK UK-HMO plan, click here. To find out if a provider is a available under the UK-HMO plan, visit our Web site at www.mc.uky.edu/ukhmo). To search for a primary care physicians, visit this page.

To view complete plan details on the UK-RHP plan, click here. Coverage is provided for emergency care at a non-participating facility only if your condition is an Emergency Medical Condition as determined by the plan. 


UK-HMO Summary of Health Plan Benefits

The UK-HMO offers an excellent value for your premium dollar. There are no deductibles to meet and no copayments for routine physicals or well child care when services are provided by a network primary care physician.


UK-HMO Factors to Consider:
  • Lexington Service Area network consists of UK HealthCare facilities (including Chandler Hospital, Good Samaritan Hospital, and Kentucky Clinics) and UK HealthCare physicians.
  • Regional Health Plan Area network includes the UK HealthCare facilities, UK HealthCare physicians and select Humana/ChoiceCare providers (use the UKHMO RSA provider link on the Humana page).
  • No referrals are required for specialty care services provided within the network.
  • No deductibles to meet.
  • No coverage for out-of-network services unless it is life or limb threatening.
  • Covered transplants include kidney, liver, pancreas, kidney/pancreas, heart, lung, heart/lung, bone marrow and cornea transplants.

Prior authorization is required for the following services:
Durable medical equipment (over $750), home health care and hospice services and other services as listed in the certificate of coverage.  Available urgent care options include: Urgent Treatment Centers in Lexington (Dove Run Road, Custer Drive, and Boardwalk Street), Nicholasville (Bellaire Drive) as well as the UK Children's Twilight Clinic.


UK-HMO and UK-RHP Summary of Health Plan Benefits

2012-2013

 

Major Plan Benefits

 

Benefits for Covered Services Provided at Participating Providers

Lifetime Maximum Benefit

 

Unlimited

Copayment Limits

Individual and Family

N/A

Preventive Care

 

 

 

Routine Pap smears, mammograms, PSA, screening colonoscopy and sigmoidoscopy
Routine child care and immunizations (through age 18)
Routine adult physical exam (19 years and above, one per plan year)

100%

 

 

Physician Services

 

 

 

 

 

 

Office visits (excludes certain diagnostic lab and X-ray)

100% after $10 copayment for primary care physician,
100% after $30 copayment for specialist,

Lab tests, X-rays and diagnostic tests

100%

Allergy injections

100% after $10 copayment

Inpatient services
Outpatient surgery and diagnostics
Physician visits to emergency room

100%

Hospital Services

 

 

 

 

Inpatient care (semi-private room and board, nursing care, ICU)

100% after $200 copayment per admission

Organ transplants
Outpatient nonsurgical care
Outpatient tests, lab and X-ray, and other diagnostic tests
Ancillary services

100%

Outpatient surgery
Outpatient diagnostic testing (high costs - MRI, MRA, CT and PET scans)

100% after $75 copayment

Emergent/Urgent Services

Emergency Room

 

Urgent Treatment Center

 

UK Children's Twilight Clinic

100% after $100 copayment (waived if admitted)

100% after $25 copayment

100% after $15 copayment

Other Medical Services

 

 

 

 

Skilled nursing facility (up to 30 days per plan year) & Hospice Services

Ambulance

100%


100%
after $75 copayment

Home health care (up to 60 visits per plan year)

80%

Durable medical equipment, orthotics and prosthetics

80%, maximum member responsibility of $500/plan year for all services combined

Hearing aids

$1,400 benefit every 36 months for children under 18

Speech therapy, pulmonary rehab therapy, physical, occupational therapy, cardiac rehab, manipulative therapy, hydrotherapy and acupuncture therapy (limited to 45 visits per plan year, combined)

 

100% after $15 copayment per visit for all therapies

Mental Health and Substance Abuse

Inpatient mental health or substance abuse

100% after $200 copayment per admission

Outpatient mental health or substance abuse

100% after $30 copayment